有限切开复位与闭合复位扩髓髓内钉治疗胫骨骨折的疗效比较  

A clinical study on comparing result of tibial shaft fractures using reamed intramedullary nail by close reduction versus limited open reduction

作　　者：孙克富[1] 冯万文[1] 杨广智[1] 黄叶建[1] 崔建国[1] 韩成相[1] 陶明高[1] 盛路新[2] 

机构地区：[1]江苏省连云港市东方医院骨科,222042 [2]江苏省连云港市第一人民医院,222003

出　　处：《齐齐哈尔医学院学报》2015年第34期5159-5161,共3页Journal of Qiqihar Medical University

基　　金：江苏省连云港市科技局骨科重点学科建设项目(SH339)

摘　　要：目的比较临床应用有限切开复位与闭合复位扩髓髓内钉治疗闭合或轻度开放胫骨骨折的疗效。方法 2013年10月至2014年10月对115例共118侧胫骨骨折采用扩髓交锁髓内钉治疗。术前分为闭合复位组52侧;有限切开复位组66侧。骨折为闭合性骨折或GustiloⅠ、Ⅱ型开放性骨折。定期随访一年以上。结果闭合复位组和有限切开复位组,平均骨折愈合时间分别为(3.4±2.78)月,(3.2±2.93)月(P>0.05),骨折延迟愈合分别为3例和4例;术后发生骨筋膜室综合征分别为1例和3例,均无不良后果,其中闭合复位组1例切开减压;平均手术时间分别为(54.1±6.14)min,(47.1±8.46)min(P<0.05);术中透视次数分别为(10.37±2.66)次和(5.92±2.13)次(P<0.05)。两组患者对于术后患肢外观满意度无明显差别。结论与闭合复位相比较,有限切开复位不增加骨折愈合时间、手术出血量,具有手术时间短,术中辐射剂量小等优点。Objective To compare clinical application of reamed intramedullary nailing treatment closed or mild open tibial fracture by closed reduction versus the limited open reduction. Methods From October 2013 to October 2014, 118 tibial shaft fractures （from 115 cases） were treated with reamed interlocking intramedullary nails. There were preoperative divided into closed reduction group, include 52 sides, and limited open reduction group with 66 sides. Fracture was closed fractures or Gustilo type I, II open fractures. Regular follow-up of more than one year. Results Closed reduction and limited open reduction group average fracture healing time was 3.4± 2.78 months and 3.2 ± 2.93 months respectively （ P 〉 0. 05 ）. There cases delayed union occurred in closed reduction group and 4 cases in the other. One patient in closed reduction group and 3 cases from limited reduction group were complicated by compartment syndrome and the patient from closed reduction group incision decompression finally. The average operation time was 54.1 ± 6.14 min and 47.1 ± 8.46 min respectively （ P 〈 0. 05）. Intraoperative fluoroscopy times respectively were 10.37 ±2.66 times and 5.92±2.13 times （P 〈 0. 05）. Two groups of patients with postoperative limb satisfaction had no obvious difference in appearance. Conclusions In comparison with closed reduction, limited open reduction and no increase in fracture healing time and the amount of operative bleeding, moreover, advantages of a short operation time and small dose of radiation.

关 键 词：胫骨骨折 骨折固定术 髓内 骨折复位 髓内钉 

分 类 号：R683.42[医药卫生—骨科学]